East Georgia Healthcare Center Inc
Organization Active NPI Migrant Health Clinic/Center · Baxley, GA
NPI 1801239389 · NPPES record last updated Aug 7, 2015
Key facts
- NPI
- 1801239389
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Migrant Health Clinic/Center 261QM1000X
- Legal business name
- EAST GEORGIA HEALTHCARE CENTER INC
- Practice address
- 1636 Hatch Parkway South
Baxley, GA 31513 - Phone
- (912) 705-5656
- Fax
- (912) 705-5652
- NPI assigned
- Apr 15, 2013
- Organization subpart
- No
Authorized official
- Name
- Jill R Sorrells
- Title
- Cfo
- Phone
- (478) 237-6262
Owners & managing parties with NPI records 18
-
Martin R Sheldon, MD
Other NPIs on the same Medicare enrollment 15
Corporate family (same tax ID) 19
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Federally qualified health center certification: CCN 111977
- Legal name
- EAST GEORGIA HEALTHCARE CENTER, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 2, 2014
- Last certification
- Apr 2, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 29, 1992 in GA
- Enrollment address
- 1636 Hatch Parkway South
Baxley, GA 31513-4376
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Joel Salgado |
Corporate Officer | Jan 1, 2021 | 10% |
| East Georgia Healthcare Center, Inc. |
Operational/Managerial Control | Jan 1, 2014 | 100% |
| Gwendolyn Love |
Corporate Director |
Apr 22, 2013 | 6% |
| Lynda Morgan |
Corporate Director |
Apr 22, 2013 | 6% |
| Theron D Faison |
Corporate Director |
Apr 22, 2013 | 5% |
| Jennie W Denmark |
W-2 Managing Employee |
Apr 22, 2013 | 6% |
| Elizabeth Hendrix |
Corporate Director |
Apr 22, 2013 | 6% |
| Cleveland White |
Corporate Director |
Apr 22, 2013 | 5% |
| Martin R Sheldon |
W-2 Managing Employee | Aug 1, 2021 | |
| Ken Mercer |
Corporate Director |
Apr 22, 2013 | 6% |
| Luis Machado |
Corporate Director |
Apr 22, 2013 | 5% |
| Amanda R Brown |
Corporate Director |
Apr 22, 2013 | 5% |
| Jill R Sorrells |
W-2 Managing Employee |
Apr 22, 2013 | 6% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050722000569 | GA | Part B Supplier - Clinic/Group Practice | 0547228686 |
Receives reassigned benefits from 49 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wadley, GA; Vidalia, GA; Sylvania, GA; Swainsboro, GA; Mount Vernon, GA; Stillmore, GA; Statesboro, GA; Soperton, GA… |
| O20140402001089 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 0547228686 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Baxley, GA |
National Provider Directory
- Tax ID family
- East Ga Hlthcare Ctr Inc
Locations
1636 Hatch Pkwy S
Baxley, GA 31513
Phone (912) 705-5656
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Migrant Health Clinic/Center | 261QM1000X | Yes |
Addresses
Primary practice location
1636 Hatch Parkway South
Baxley, GA 31513
Mailing address
215 N Coleman St
Swainsboro, GA 30401-3530
Phone (478) 237-6262
Other providers in Baxley, GA
- Ray Ashley Dixon
- Doctors of Compassionate Services
- Robert D Drawdy
- Dva Renal Healthcare Inc
- E Buford Kesler Dba
- Melina Edmund
- Barbara Nicole Ellis
- Excelcare Ambulance Service, Inc
- Family Medicine of Baxley Inc.
- Alyse Fandrich
All providers in Baxley, GA · Migrant Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.